To Galvanize Local Push for Medicare for All in 2019, Nurses' Union Organizing Nationwide 'Barnstorms'
by Julia Conley - Common Dreams - December 31, 2018
As progressive groups push Democratic leaders on Capitol Hill to bring Medicare for All legislation up for a vote in the new year—a move that would bring Congress closer to passing a proposal supported by 70 percent of voters—one of the nation's leading advocates for a single-payer system is asking supporters to make their voices heard in the fight to make universal healthcare a reality in the United States.National Nurses United (NNU), which has been fighting for the proposal since the union's founding in 2009, is asking members and supporters to host Medicare for All "barnstorms" during a National Week of Action from February 9th to 13th.
"To build the mass collective action we know we'll need to win, we're asking activists like you across the country to organize a Medicare for All barnstorm in your community," the group wrote to supporters in its petition asking for volunteers. "At the barnstorm you'd gather with volunteers near you, talk about the plan to win, and begin organizing to knock doors, make phone calls, and more in your community."
Organizers believe that the barnstorms will demonstrate the widespread support that Medicare for All has gained in recent years, especially among Democratic voters—84 percent of whom support the proposal—as the Progressive Change Campaign Committee (PCCC) and other groups call on the new Democratic House majority to push for a vote on the legislation.
"If Congress brings Medicare For All for a vote, we will see who stands with over 70 percent of Americans, and who stands with the lobbyists. Then we'll know who needs persuasion—and who needs a primary," said the PCCC last week.
Public support for Medicare for All has grown amid repeated attacks on the Affordable Care Act (ACA)—the latest of which came in the form of a federal judge's ruling earlier this month that declared the ACA unconstitutional.
Progressives have pointed to such attacks as clear evidence that Medicare for All legislation would provide a stable healthcare system that would extend care to all Americans. As such, proponents are calling for expanding and improving one of the most popular government-run programs instead of allowing states to administer, or refuse to administer, the ACA's provisions while continuing to prop up the for-profit health insurance industry.
While U.S. District Court Judge Reed O'Connor ruled that the ACA is unconstitutional due to its individual mandate requiring all Americans to purchase insurance, Rep. Ro Khanna (D-Calif.) noted, Medicare for All would be immune from such claims.
"There's no doubt that would be constitutional. Medicare is already constitutional and what we're saying is extend it to everyone, so there can be no constitutional argument," Khanna told The Hill last week.
The lawsuit, which followed the Republicans' attempt to repeal the ACA in 2017 and the Trump administration's expansion of short-term healthcare plans, among other sabotage efforts, "is one more example of how tenuous the law really is," Eagan Kemp of the advocacy group Public Citizen, told The Hill.
"You don't see the same type of sabotage to Medicare. So to me it highlights that the Medicare program remains the third rail of politics, so if we're going to build a new health-care system, it's something that can be safe," Kemp said.
Though Sen. Bernie Sanders' (I-Vt.) Medicare for All proposal now has the support of 15 senators, some Democrats have continued to insist in recent weeks that the plan is somehow "unrealistic" or difficult to afford—despite the fact that even a study by the Koch brothers-funded Mercatus Center found that the plan would $2 trillion less over ten years compared to the current for-profit system.
"We all support Medicare for all," said former Virginia Gov. Terry McAuliffe—who is rumored to be a 2020 presidential candidate—in an interview with CNN over the weekend. "But we have got to figure out how we pay for it. It's unrealistic in terms of how we pay for it today."
McAuliffe was quickly rebuked on social media by advocates who know that with current total healthcare expenditures at $3.5 trillion in 2017—up from 2016—Americans would spend at least $35 trillion on healthcare over the next 10 years under the current system, instead of the $32.6 trillion that Medicare for All is projected to cost.
https://www.commondreams.org/news/2018/12/31/galvanize-local-push-medicare-all-2019-nurses-union-organizing-nationwide-barnstormsDear politicians saying we can't afford #MedicareForAll:You're just wrong, factually incorrect.
What you're rly saying is you:
1) are sold to the system
2) afraid to speak truth to big corps
2) don't comprehend how we pay for healthcare now
3) don't care to fix the problem
— Abdul El-Sayed (@AbdulElSayed) December 30, 2018
2019: The Year of Medicare for All
by Zenei Cortez - Common Dreams - January 3, 2019
Early in this new year, Rep. Pramilla Jayapal (D-Wa.) will be introducing an updated version of a House Medicare for All bill, buttressed by the election in November of a number of new Medicare for all House candidates. Re-introduction of a Senate bill by Sen. Bernie Sanders (I-Vt.) is also expected soon.Nurses and other health activists are already gearing up to increase the number of co-sponsors, especially for the House bill, long known as HR 676, and push for action on the bill now that the Democrats will be in the majority again.
Hundreds of activists have participated in organizing, that will include barnstorming in early February for public events and to press Congress members who have not signed on to the bill. Both Jayapal and Sanders joined a national conference call, sponsored by National Nurses United, following the election, to promote the organizing campaign. A barnstorm is a mass organizing meeting to kick start action on Medicare for all in local communities.
Polls show growing national support, as much as 70 percent, 85 percent among Democrats, and even a majority of Republicans, for a publicly financed, guaranteed health care solution. Those numbers, which reflect widespread public anxiety over a dysfunctional health care system, and the election of more Medicare for All supporters, have spawned the formation of an alarmed industry sponsored effort to block the single payer movement.
But frequent news reports demonstrate why the need for Medicare for All will only continue to grow. Here’s a sampling just from the past month:
Four in 10 adults say they are living paycheck to paycheck and could not produce $400 in an emergency without sliding into debt or selling something, the Washington Post reported.
Four in 10 adults say they are living paycheck to paycheck and could not produce $400 in an emergency without sliding into debt or selling something, the Washington Post reported.
Medical bills from an unexpected illness or accident are the leading cause of financial emergency for Americans – a point emphasized in a Kaiser Health News article featured by NPR under the telling headline “Insured, But Indebted: Couple Works 5 Jobs To Pay Off Medical Bills.”
Uninsured rates rose by some 700,000 people, in 2017 in 36 states, even some that expanded Medicaid coverage through the Affordable Care Act (ACA), the Kaiser Family Foundation noted.
Trump Administration and rightwing attacks on the ACA are taking their toll. Escalating out of pocket costs are increasing the number of people who resort to buying high deductible plans with thousands of dollars in deductibles, huge co-pays for critical care such as emergency room visits and surgeries, and exclusion of coverage for prescription drugs or other basics.
Overall, KFF reported, about 4.4 million fewer people who buy coverage on their own were insured in 2018 compared to 2015, Most of the drop occurred among people who don’t get ACA subsidies which have not kept up with the rising costs.
Even people with employer-paid health plans are seeing their cost for premiums rising, according to a Commonwealth Fund study on top of earlier reports about the cost shifting by employers to workers as well in deductibles and co-pays.
While much of the focus has understandably been on costs to individuals and families, who frequently respond by skipping needed medical care, there is also rampant evidence of worrisome declines in health barometers as well as the ongoing racial disparity of a discriminatory system.
Behind all of these disheartening statistics are real people, enduring pain and suffering that should be unacceptable in the wealthiest country on earth.
Average life expectancy in the U.S. declined in 2017 for the fourth year in a row, which the Washington Post noted was the “longest sustained decline in expected life span at birth in a century, dating back to the global flu pandemic of 1915-1919 that killed 50 million people worldwide including 675,000 in the U.S.
A subsequent Vox report made the significant addendum to the data that the decline is concentrated among middle and low income Americans while life expectancy has actually increased for the richest Americans. That’s predictable for a system structured on ability to pay, not patient need.
The inequality also extends to race and gender. The rise in the uninsured rate, for example, is much higher among Latinos and African-Americans. Death rates linked to heart disease, diabetes, cancer, infant mortality, and HIV/AIDS at an early age are higher for African Americans than for whites, and Black women are three to four times more likely to die in child birth than are white women.
Behind all of these disheartening statistics are real people, enduring pain and suffering that should be unacceptable in the wealthiest country on earth.
The most effective solution is not minor tweaks to the ACA, or any of the market-based proposals beloved by the conservative politicians and policy wonks which is the very reason for the crisis of a system even the ACA could not eliminate. It’s why public support for Medicare for All is swelling, and will surely be a major focus in the new year.
https://www.commondreams.org/views/2019/01/02/2019-year-medicare-all?cd-origin=rss&utm_term=2019%3A%20The%20Year%20of%20Medicare%20for%20All&utm_campaign=2019%3A%20The%20Year%20of%20Medicare%20for%20All%20%7C%20News%20%2526%20Views&utm_content=email&utm_source=Daily%20Newsletter&utm_medium=Email&cm_mmc=Act-On%20Software-_-email-_-2019%3A%20The%20Year%20of%20Medicare%20for%20All%20%7C%20News%20%2526%20Views-_-2019%3A%20The%20Year%20of%20Medicare%20for%20All
House Democrats plan to hold hearings on Medicare for All
by David Weigel - The Washington Post - January 3, 2019
The new Democratic majority in the House will hold
the first hearings on Medicare-for-All legislation, a longtime goal of
the party’s left, after Speaker Nancy Pelosi lent her support for the
process.
“It’s a huge step forward to have the
speaker’s support,” said Rep. Pramila Jayapal (D-Wash.), who will be the
House sponsor of the legislation, usually denoted as HR 676. “We have
to push on the inside while continuing to build support for this on the
outside.”
Some version of universal health care
has been a Democratic goal for decades. The Expanded and Improved
Medicare for All Act, first introduced in 2003 by then-Rep. John Conyers
Jr. of Michigan, has become the vehicle for Democrats who want to bring
single-payer, Canada-style health care to the United States.
That
legislation was typically sidelined, even when Democrats had power; in
2009 and 2010, when the House passed the Affordable Care Act, the
“Medicare-for-All” package was not part of the discussion. But in his
2016 campaign for president, Sen. Bernie Sanders (I-Vt.) championed
Medicare for All. The following year, for the first time, a majority of
House Democrats co-sponsored HR 676.
“I
want to congratulate the House for holding hearings for the first time
on Medicare for All,” Sanders told The Washington Post on Thursday. “I’m
confident the results will show that Medicare for All is the way
forward if we want to guarantee heath care to all people in a
cost-effective way.”
Pelosi, who had been a co-sponsor, said throughout
the 2018 campaign that Democrats were free to discuss many other
health-care programs. She strongly suggested that a Democratic House
would at least hold hearings on the far-reaching Jayapal bill; on
Wednesday, Jayapal got Pelosi’s commitment to hearings in the Rules and
Budget committees.
The incoming chairmen of those committees, Reps. Jim
McGovern (D-Mass.) and John Yarmuth (D-Ky.), support Medicare for All,
and Yarmuth had told reporters last year that he would like to use his
committee for hearings on how single-payer health care could work.
“The
American people deserve to know what the various options for Medicare
for All would mean to them as health care consumers and taxpayers,”
Yarmuth said.
Jayapal said supporters hope to release legislation in “the next couple of weeks” and hold hearings in a number of committees.
With
Democrats locked out of power in the Senate and the White House,
Jayapal said that supporters of universal health care were proceeding
“one step at a time” and that getting the first real hearings on the
bill — for years, it has been aspirational, and not even subject to a
Congressional Budget Office score — would force a larger discussion.
“This will ensure that Medicare for All is part of the 2020 Democratic presidential platforms,” said Jayapal.
Polling has found support for Medicare for All
at anywhere from 58 to 70 percent, though critics point out that
support dips depending on how the costs and changes to private insurance
are described.
Outside
of Congress, supporters of ambitious liberal bills have viewed the new
House warily. Later Thursday, the House is set to amend, but not
eliminate, the “paygo” rule that requires any new spending to be offset
with deficit reduction.
While Democratic leaders have pointed out that the spending rule is statutory and would remain active in the Senate no matter what the House does, a number of left-leaning Democrats have accused
Pelosi of preemptively making it harder to pass major reforms. Jayapal,
a co-chair of the Congressional Progressive Caucus who helped reshape
the rule, said that those concerns were unfounded.
“The
critical thing here is: Do we have a commitment to waive paygo on
critical bills? I think we do,” she said. “I think we’ve not only got a
commitment for that, but for hearings on those bills, and we’ve never
had that before.”
https://www.washingtonpost.com/powerpost/democrats-plan-to-hold-hearings-on-medicare-for-all/2019/01/03/7051eccc-0f6c-11e9-84fc-d58c33d6c8c7_story.html?utm_term=.4a4dd4478994
Every year, millions of people are losing access to the doctors they know and trust either because their jobs end, they switch jobs, their employers switch their health insurance or their health insurance changes its in-network providers. So, unlike the health care system today, in which people cannot count on continuity of care from the doctors they know and trust or cannot count on being able to afford out-of-pocket costs to get the care they need, Medicare for all delivers on both counts. Yes, people must switch their insurance, but is that what anyone really cares about?
Dylan Scott reports for Vox on surveys suggesting that the 160 million Americans with employer coverage generally like it. But, what does that tell you? The important question is why people like their insurance rather than whether they like it. My bet is that most people like their employer coverage because of the access to care it offers and could not care less about the insurance company offering their coverage or the brand of insurance they have.
Whereas people swear by their Hondas and Audis, have you ever met anyone who speaks highly of Aetna or United Health Care. People tend to like it when their costs are relatively low and they are able to see doctors they want to see, an entirely different proposition.
Scott also writes about the health insurance choices people with employer health insurance value and would not want to lose. Really? I cannot name a soul who enjoyed making a choice of a health plan or felt that he or she could even understand the different choices. How could anyone feel good about choosing a plan without knowing whether it will deliver them the care they need at a price they can afford?
That’s the beauty of Medicare for all and why 70 percent of Americans now support it. Americans want to know their health insurance will get them the care they need, from the doctors they trust, at a price they can afford. The latest study shows that improved Medicare for all–covering dental, vision and hearing without copays and deductibles saves middle-income families between 2.6 percent and 14 percent of their annual income, and it saves the nation more than $5 trillion over 10 years.
So, why isn’t Medicare for all a slam dunk? People would get to see the doctors they want to see at less cost than today. There’s one major reason–the powerful health insurance industry and its allies. They will lobby hard and advertise to ensure misinformation flows endlessly. Much as Harry and Louise TV ads fooled people into believing that their commercial health insurance was simpler and better than a government plan, you can be sure that the insurance industry will try to do same with Medicare for all. The insurers have everything to lose.
In this next round of health reform, the commercial insurers should have a rougher time. No one now thinks that their commercial health insurance is anything but complicated. Everyone now realizes that their commercial health insurers come between them and their doctors.
And, people increasingly see that employer coverage can neither guarantee everyone health care nor control costs, except by delaying and denying coverage. Moreover, it creates job lock. Americans do not want to depend on their jobs for decent health care coverage nor do they want to give up a big chunk of their wages—as they must do today—to pay for health insurance.
Health care is not a commodity. And, the companies selling health insurance are, at their core, different from the companies selling automobiles and other commodities. It is not possible for them to do their job–compete to provide good health care to all the people who need it–and survive financially. To maximize profits, the health insurance companies do not want to sell health insurance to the people who most need it. In stark contrast, to maximize profits, the automobile companies compete to sell as many automobiles as possible; they do not care who buys them.
Unlike Medicare for all, which is designed to pool and broadly distribute costs to ensure care for everyone, the commercial health care system is not one that can ever work for Americans who most need care. Medicare for all. One choice that meets everyone’s needs rather than many incomprehensible commercial insurance choices designed not to meet people’s high-cost care needs. Let’s do it!
http://justcareusa.org/for-americans-medicare-for-all-means-continuity-of-care/?
The Hill reports on the latest Reuters-Ipsos poll, which shows that seven in ten Americans now support Medicare for All, an improved and expanded Medicare program for everyone in the US. More than eight in ten (84 percent) Democrats and more than half of Republicans (52 percent) want the government to step in and improve and expand Medicare.
These new poll results, based on the responses of 2,989 Americans, are a big step forward for Medicare for All in just a few months. A previous poll showed that more than six in ten Americans support Medicare for All. It also showed that 43 percent of Republicans support Medicare for All.
Government-administered health care could easily save ordinary Americans a few thousand dollars a year on health care costs. With Medicare for All, our federal taxes would pay for health care, and we would no longer pay insurance premiums, deductibles or copays. Medicare for All would cover vision, dental, and hearing care, in addition to other medically reasonable and necessary benefits.
Today, our taxes support basic needs like the police, the fire department and public education. They should also guarantee our health care.
http://justcareusa.org/mounting-support-for-medicare-for-all/
The economists project a 19.2 percent savings in national health spending, even assuming a 12 percent increase in use of health care services. In short, improved Medicare for All would bring down annual health care spending to $2.93 trillion from its current level of $3.24 trillion. They found significant savings from lower administrative costs, lower provider rates and lower prescription drug costs. In total, they found that overall spending could fall by about 10 percent.
They estimated that overall spending would decrease by 9 percent from administrative savings; 5.9 percent from lowering prescription drug costs by 40 percent; 2.8 percent savings by putting in place uniform doctor and hospital rates and finally, 1.5 percent savings from a reduction in fraud and waste in the current system.
The biggest winners are middle class households, Your typical middle income family should see its net health care spending fall between 2.6 and 14 percent of their income.
How does the federal government pay for improved Medicare for all? The economists explain that the public sector already pays 60 percent of all health care costs. They suggest one way to pay for the remaining costs is to impose a sales tax of 3.75 percent on non-necessities. They also propose imposing a wealth tax of 0.38 percent on the top 12 percent of households. And they propose treating long term capital gains as short term gains for tax purposes.
They propose that businesses pay an 8 percent payroll contribution; still, they estimate that businesses would see an average of 8 percent savings on employee premiums. People with Medicaid would get a tax credit.
The economists recognize that the transition to Medicare for all needs to address the 1.8 million jobs lost from the transition away from commercial health insurance. And, they propose guaranteeing people’s pensions and providing them two years full pay if they are retiring. For those remaining in the workforce, they propose 100 percent wage insurance for one year and job retraining. The total projected cost is $120 billion over the course of the transition, which is covered by the savings and new sources of proposed revenue.
http://justcareusa.org/new-study-finds-medicare-for-all-generates-overall-savings-of-more-than-5-trillion/
With the midterms over, a battle over health care policy among establishment Democrats and the grassroots is unfolding. What kind of health care reform should Democrats pursue now that they have won control of the House? This struggle will determine in large part how Democrats will spend the political capital the party has accumulated on the issue of health care. This is a considerable amount thanks to the GOP’s efforts to take health care away from millions and ongoing war against Medicaid. How this battle transpires over the next two years may go a long way in determining if Medicare for All can become policy, or simply remains a “goal” or an “aspiration.”
Single-payer advocates, jubilant about record support in Congress and in public polls, have responded to the midterm success by boldly pushing for a floor vote on Medicare for All (H.R. 676) during the 116th Congress. This move would not result in a law as it has no chance in the Senate. It would, however, represent a huge symbolic victory and, ideally, plant HR 676 as the centerpiece of the Democratic Party’s health care platform.
Much of the work that is being planned by major players in the movement was discussed in a post-midterm strategy call hosted by National Nurses United and attended by Sen. Bernie Sanders, Rep. Pramila Jayapal and speakers from Healthcare-NOW!, Physicians for a National Health Program and Democratic Socialists of America. In the call, Sanders warned of the opposition from “Trump and his minions” and the private health industry. But of all the speakers, only one, Dr. Adam Gaffney, president of Physicians for a National Health Program (PNHP), warned of the dangers posed by Democrats and the threat of “a slew of half-measures.”
Gaffney is right to be concerned about Democrats undermining efforts to improve and expand health care. Since the midterms, so-called moderate Democrats have gone on an increasingly loud offensive for a “practical” alternative to Medicare for All: a public option (also called a Medicaid Buy-In or “Medicare for Some“). The United States of Care, a group started by former Obama official Andy Slavitt that promotes bipartisan solutions, also recently released a memo about various Medicaid Buy-In proposals. The Center for American Progress has offered its own version of this kind of policy, as have numerous legislators.
The basic idea is rather than create a universal health care plan for all, preserve the status quo but add a new optional Medicare product to be sold on the exchange to a limited group of people ages 50-64, although the exact details vary in the many different public option plans that exist (this is a useful comparison of existing proposals). Some advocates for a public option argue it can lead to single-payer, but leaders of the movement and experts on health care argue it would be counterproductive. This is because the public option will attract high-risk patients and would have little impact on costs or access. The primary appeal of single-payer is to benefit from a simplified process and wider risk pool that spreads cost equally across the country. None of this would happen under a public option.
The leading face of this centrist proposal, which would add a limited product to a hopelessly broken market and hijack energy from the single-payer movement, is Rep. Bill Higgins of New York. He is also one of the 123 co-sponsors of Medicare for All in the House, which is rather unsettling to single-payer enthusiasts.
This dynamic raises a serious question that organizers must grapple with. While political pressure from advocates has created many new Democrats who publicly support Medicare for All, there are concerns about the intensity and authenticity of support among many of them. For support to have practical meaning, members of Congress must try to advance the policy. Yet many Democrats made a point to qualify their support for Medicare for All as “aspirational,” and essentially symbolic. With ready-made alternatives to Medicare for All already available, the next big fight for single-payer may not be with Big Pharma or the GOP, but rather, Democrats who insist on putting their energy behind weaker policies.
“If Democrats coalesce around half-measures like the public option, it would squander the political capital Democrats have accumulated on health care on solutions that we know do not work,” Gaffney told Truthout.
This issue highlights what author and activist Norman Solomon says is a “fundamental issue that progressives must deal with in the coming years – and not just for Medicare for All,” but a number of policies.
“It is not enough for Democrats to say they will support something,” said Solomon. “What matters is: Will they advance the legislation? Will they represent the grassroots? This is at the heart of what the grassroots needs to do. We need to hold politicians, even ones we like, accountable for what they do, not just what they say.”
Despite co-sponsoring Medicare for All, Higgins is clearly not interested in pursuing the reform any time soon. “I support the exploration of Medicare for all, but you have to be well balanced and practical about this,” he said (emphasis added).
It appears Pelosi and Higgins found common ground (though what their dispute was over a public option remains a mystery). After their meeting, Higgins told the Buffalo News he would give his support to Pelosi and they agreed that he be the lead person on the Medicare Buy-In.
That the pair found common ground is not surprising. Pelosi has long been a darling of the private health industry. She collected more than $500,000 from the private health sector in contributions between 2017 and 2018. The private health industry would prefer a New Democrat like Higgins (who himself collected nearly $115,000 in industry money in 2018) to be the face of Democratic health care reform, as opposed to Alexandria Ocasio-Cortez or Bernie Sanders.
Higgins also has a close relationship with Rep. Richard Neal, the powerful ranking member (and likely the next chairman) of the House Ways and Means Committee, which is one of two committees to have jurisdiction over health policy. (The other one is the Energy and Commerce Committee.) Neal, who has received more than $2 million in his career from the industry, hosted a fundraiser breakfast for Higgins in 2017, indicating a close working relationship.
Rep. Frank Pallone (D-New Jersey), the ranking member of the Energy and Commerce committee, has received about $6 million from the health industry throughout his career and has said, “We [the committee] certainly would consider a Medicare buy-in.”
Single-payer strategists, according to the strategy call made in November, are targeting the chairs of these committees. To date, neither chair has given any words of support for single-payer.
“This is a fight that is not going to be easy,” said Gaffney. “The other side will always have more money and more political connections.”
This was especially evident among senators who co-sponsored Sanders‘s Medicare for All bill in 2017. When Sanders’s bill garnered 16 co-sponsors, advocates were elated, and understandably so. In the past, Sanders could not find one solitary co-sponsor in the Senate for any single-payer bill.
But the great lengths some of these politicians went to distance themselves from their own support has been a source of concern among many advocates.
Then-Sen. Al Franken’s response might be the most absurd qualification his “support” for Medicare for All (this came before the Minnesota senator resigned over sexual misconduct):
Other Democrats, including possible presidential contenders, followed suit (before Franken’s scandal he had been rumored as a possible presidential contender as well). For instance, Sen. Cory Booker said he would co-sponsor the bill, but in doing so, said he “won’t rest until every American has a basic security that comes from access to affordable health care.
“Access to affordable health care” is not the same thing as a guarantee to comprehensive health care. In fact, the statement alone cedes health care as a commodity, which is not very different from the language the GOP used to try to make its reforms sound palatable — “universal access.” In countries like Canada, Japan and the United Kingdom, citizens don’t merely have “access to affordable care”; they are automatically enrolled — for life — under the nations’ single-payer systems.
Sen. Kamala Harris of California is also a co-sponsor of the bill, but in a later interview up with the Sacramento Bee, she said, “as we talk about moving toward a single-payer system, I think that there’s certainly momentum and energy around that, and when I get back to D.C., I’ll have a better sense of where people are now that they’ve been home.”
These high-profile equivocations worry some single-payer advocates.
“It has become difficult for any Democratic senator considering a 2020 presidential bid not to co-sponsor Sanders’ bill, a sign that support for single-payer will be the default position,” wrote Jim Newell in Slate. “These [co-sponsors] need to show, in short, that they’re not duping single-payer supporters to get their votes—that they care about single-payer health care as a government program they’re serious about implementing, and not just as a talking point.”
This weak-kneed support is seen outside of Congress as well. For instance, it became common for the press to conclude that former President Barack Obama has “endorsed” Medicare for All, when in fact, his comments were much less committal and somewhat confusing. Obama misidentified Medicare for All as a new idea, though he expressed support for the policy as far back as 2003.
This is one reason why Sanders’s bill did not get specific about financing (the staff chose to release a memo outlining possible ways to pay for the plan). The way his legislation was written allowed senators to co-sponsor without technically supporting any new taxes.
But, given the finite amount of time and political capital that exists, organizers say, politicians can’t play it safe much longer.
“Politicians will try very hard to avoid making hard decisions,” Solomon said. “But eventually, you have to decide: Is health care a right or not?”
One way to ensure that members of Congress who are sincere in their support for Medicare for All is to run primary opponents against Democrats who don’t advance single-payer. Many of the self-described Democratic Socialists won in the midterms through their strong support for Medicare for All and refusal to accept money from major corporate donors and the private health industry.
Ocasio-Cortez has endorsed this tactic, not just on health care but on many issues, to reform the party. Her victory is an example of a strong supporter of single-payer running against a politician whose decision to support single-payer was viewed with great skepticism among progressives. Joseph Crowley, was, like Higgins, among the 123 co-sponsors to HR 676 when he lost to Ocasio-Cortez. While Crowley had never endorsed the bill in past congressional terms, he did so in May 2017 after the Sanders campaign managed to push the issue into the national spotlight. Moderates like Crowley felt tremendous pressure from the left to co-sign single payer.
For Americans, Medicare for all means continuity of care and far less disruption than the status quo
by Diane Archer - JustCare - January 2, 2019
There’s a lot of chatter about the “disruption” Medicare for all will cause. In fact, for Americans, Medicare for all means continuity of care and far less disruption than the status quo. The transition to Medicare for all should be smooth sailing, a seamless and simple move out of commercial health insurance. The disruption will be in the commercial health insurance market.Every year, millions of people are losing access to the doctors they know and trust either because their jobs end, they switch jobs, their employers switch their health insurance or their health insurance changes its in-network providers. So, unlike the health care system today, in which people cannot count on continuity of care from the doctors they know and trust or cannot count on being able to afford out-of-pocket costs to get the care they need, Medicare for all delivers on both counts. Yes, people must switch their insurance, but is that what anyone really cares about?
Dylan Scott reports for Vox on surveys suggesting that the 160 million Americans with employer coverage generally like it. But, what does that tell you? The important question is why people like their insurance rather than whether they like it. My bet is that most people like their employer coverage because of the access to care it offers and could not care less about the insurance company offering their coverage or the brand of insurance they have.
Whereas people swear by their Hondas and Audis, have you ever met anyone who speaks highly of Aetna or United Health Care. People tend to like it when their costs are relatively low and they are able to see doctors they want to see, an entirely different proposition.
Scott also writes about the health insurance choices people with employer health insurance value and would not want to lose. Really? I cannot name a soul who enjoyed making a choice of a health plan or felt that he or she could even understand the different choices. How could anyone feel good about choosing a plan without knowing whether it will deliver them the care they need at a price they can afford?
That’s the beauty of Medicare for all and why 70 percent of Americans now support it. Americans want to know their health insurance will get them the care they need, from the doctors they trust, at a price they can afford. The latest study shows that improved Medicare for all–covering dental, vision and hearing without copays and deductibles saves middle-income families between 2.6 percent and 14 percent of their annual income, and it saves the nation more than $5 trillion over 10 years.
So, why isn’t Medicare for all a slam dunk? People would get to see the doctors they want to see at less cost than today. There’s one major reason–the powerful health insurance industry and its allies. They will lobby hard and advertise to ensure misinformation flows endlessly. Much as Harry and Louise TV ads fooled people into believing that their commercial health insurance was simpler and better than a government plan, you can be sure that the insurance industry will try to do same with Medicare for all. The insurers have everything to lose.
In this next round of health reform, the commercial insurers should have a rougher time. No one now thinks that their commercial health insurance is anything but complicated. Everyone now realizes that their commercial health insurers come between them and their doctors.
And, people increasingly see that employer coverage can neither guarantee everyone health care nor control costs, except by delaying and denying coverage. Moreover, it creates job lock. Americans do not want to depend on their jobs for decent health care coverage nor do they want to give up a big chunk of their wages—as they must do today—to pay for health insurance.
Health care is not a commodity. And, the companies selling health insurance are, at their core, different from the companies selling automobiles and other commodities. It is not possible for them to do their job–compete to provide good health care to all the people who need it–and survive financially. To maximize profits, the health insurance companies do not want to sell health insurance to the people who most need it. In stark contrast, to maximize profits, the automobile companies compete to sell as many automobiles as possible; they do not care who buys them.
Unlike Medicare for all, which is designed to pool and broadly distribute costs to ensure care for everyone, the commercial health care system is not one that can ever work for Americans who most need care. Medicare for all. One choice that meets everyone’s needs rather than many incomprehensible commercial insurance choices designed not to meet people’s high-cost care needs. Let’s do it!
http://justcareusa.org/for-americans-medicare-for-all-means-continuity-of-care/?
Mounting support for Medicare for All
by Diane Archer - Just Care - September 18, 2018
As health care costs continue to grow, so does support for Medicare for All. More Americans see health care as a basic need and a fundamental right. They want the government to step in and oversee our health care.The Hill reports on the latest Reuters-Ipsos poll, which shows that seven in ten Americans now support Medicare for All, an improved and expanded Medicare program for everyone in the US. More than eight in ten (84 percent) Democrats and more than half of Republicans (52 percent) want the government to step in and improve and expand Medicare.
These new poll results, based on the responses of 2,989 Americans, are a big step forward for Medicare for All in just a few months. A previous poll showed that more than six in ten Americans support Medicare for All. It also showed that 43 percent of Republicans support Medicare for All.
Government-administered health care could easily save ordinary Americans a few thousand dollars a year on health care costs. With Medicare for All, our federal taxes would pay for health care, and we would no longer pay insurance premiums, deductibles or copays. Medicare for All would cover vision, dental, and hearing care, in addition to other medically reasonable and necessary benefits.
Today, our taxes support basic needs like the police, the fire department and public education. They should also guarantee our health care.
http://justcareusa.org/mounting-support-for-medicare-for-all/
New study finds Medicare for all generates overall savings of more than $5 trillion
by Diane Archer - Just Care - December 6, 2018
Health economists from the University of Massachusetts at Amherst just released a report, which finds that Medicare for All generates national health care savings of more than $5 trillion over ten years. Those savings come with insuring every American, providing excellent benefits, including vision, hearing, dental and prescription drugs, and no premium, deductibles or coinsurance.The economists project a 19.2 percent savings in national health spending, even assuming a 12 percent increase in use of health care services. In short, improved Medicare for All would bring down annual health care spending to $2.93 trillion from its current level of $3.24 trillion. They found significant savings from lower administrative costs, lower provider rates and lower prescription drug costs. In total, they found that overall spending could fall by about 10 percent.
They estimated that overall spending would decrease by 9 percent from administrative savings; 5.9 percent from lowering prescription drug costs by 40 percent; 2.8 percent savings by putting in place uniform doctor and hospital rates and finally, 1.5 percent savings from a reduction in fraud and waste in the current system.
The biggest winners are middle class households, Your typical middle income family should see its net health care spending fall between 2.6 and 14 percent of their income.
How does the federal government pay for improved Medicare for all? The economists explain that the public sector already pays 60 percent of all health care costs. They suggest one way to pay for the remaining costs is to impose a sales tax of 3.75 percent on non-necessities. They also propose imposing a wealth tax of 0.38 percent on the top 12 percent of households. And they propose treating long term capital gains as short term gains for tax purposes.
They propose that businesses pay an 8 percent payroll contribution; still, they estimate that businesses would see an average of 8 percent savings on employee premiums. People with Medicaid would get a tax credit.
The economists recognize that the transition to Medicare for all needs to address the 1.8 million jobs lost from the transition away from commercial health insurance. And, they propose guaranteeing people’s pensions and providing them two years full pay if they are retiring. For those remaining in the workforce, they propose 100 percent wage insurance for one year and job retraining. The total projected cost is $120 billion over the course of the transition, which is covered by the savings and new sources of proposed revenue.
http://justcareusa.org/new-study-finds-medicare-for-all-generates-overall-savings-of-more-than-5-trillion/
Biggest Threat to Single-Payer? Democrat Support for a Public Option
by Michael Corcoran - Truthout - January 4, 2019With the midterms over, a battle over health care policy among establishment Democrats and the grassroots is unfolding. What kind of health care reform should Democrats pursue now that they have won control of the House? This struggle will determine in large part how Democrats will spend the political capital the party has accumulated on the issue of health care. This is a considerable amount thanks to the GOP’s efforts to take health care away from millions and ongoing war against Medicaid. How this battle transpires over the next two years may go a long way in determining if Medicare for All can become policy, or simply remains a “goal” or an “aspiration.”
Single-payer advocates, jubilant about record support in Congress and in public polls, have responded to the midterm success by boldly pushing for a floor vote on Medicare for All (H.R. 676) during the 116th Congress. This move would not result in a law as it has no chance in the Senate. It would, however, represent a huge symbolic victory and, ideally, plant HR 676 as the centerpiece of the Democratic Party’s health care platform.
Much of the work that is being planned by major players in the movement was discussed in a post-midterm strategy call hosted by National Nurses United and attended by Sen. Bernie Sanders, Rep. Pramila Jayapal and speakers from Healthcare-NOW!, Physicians for a National Health Program and Democratic Socialists of America. In the call, Sanders warned of the opposition from “Trump and his minions” and the private health industry. But of all the speakers, only one, Dr. Adam Gaffney, president of Physicians for a National Health Program (PNHP), warned of the dangers posed by Democrats and the threat of “a slew of half-measures.”
Gaffney is right to be concerned about Democrats undermining efforts to improve and expand health care. Since the midterms, so-called moderate Democrats have gone on an increasingly loud offensive for a “practical” alternative to Medicare for All: a public option (also called a Medicaid Buy-In or “Medicare for Some“). The United States of Care, a group started by former Obama official Andy Slavitt that promotes bipartisan solutions, also recently released a memo about various Medicaid Buy-In proposals. The Center for American Progress has offered its own version of this kind of policy, as have numerous legislators.
The basic idea is rather than create a universal health care plan for all, preserve the status quo but add a new optional Medicare product to be sold on the exchange to a limited group of people ages 50-64, although the exact details vary in the many different public option plans that exist (this is a useful comparison of existing proposals). Some advocates for a public option argue it can lead to single-payer, but leaders of the movement and experts on health care argue it would be counterproductive. This is because the public option will attract high-risk patients and would have little impact on costs or access. The primary appeal of single-payer is to benefit from a simplified process and wider risk pool that spreads cost equally across the country. None of this would happen under a public option.
The leading face of this centrist proposal, which would add a limited product to a hopelessly broken market and hijack energy from the single-payer movement, is Rep. Bill Higgins of New York. He is also one of the 123 co-sponsors of Medicare for All in the House, which is rather unsettling to single-payer enthusiasts.
This dynamic raises a serious question that organizers must grapple with. While political pressure from advocates has created many new Democrats who publicly support Medicare for All, there are concerns about the intensity and authenticity of support among many of them. For support to have practical meaning, members of Congress must try to advance the policy. Yet many Democrats made a point to qualify their support for Medicare for All as “aspirational,” and essentially symbolic. With ready-made alternatives to Medicare for All already available, the next big fight for single-payer may not be with Big Pharma or the GOP, but rather, Democrats who insist on putting their energy behind weaker policies.
“If Democrats coalesce around half-measures like the public option, it would squander the political capital Democrats have accumulated on health care on solutions that we know do not work,” Gaffney told Truthout.
This issue highlights what author and activist Norman Solomon says is a “fundamental issue that progressives must deal with in the coming years – and not just for Medicare for All,” but a number of policies.
“It is not enough for Democrats to say they will support something,” said Solomon. “What matters is: Will they advance the legislation? Will they represent the grassroots? This is at the heart of what the grassroots needs to do. We need to hold politicians, even ones we like, accountable for what they do, not just what they say.”
New Democrat Goes on Centrist Offensive
Rep. Higgins, the most visible face of this strategy, is a member of the centrist New Democrat Coalition. He briefly opposed Nancy Pelosi’s speakership as part of a group of hold-outs that mostly stemmed from the party’s right-leaning plank. In explaining his rationale in opposing Pelosi’s speakership, he went on a media offensive in late November to advocate for a Medicaid Buy-In program. This early, aggressive gambit gave centrists a chance to plant flagship health policy for Democrats post-midterm and succeeded in shaping the narrative. “Momentum is building among House Democrats for a more moderate alternative to single-payer health-care legislation,” the Hill reported on November 29.Despite co-sponsoring Medicare for All, Higgins is clearly not interested in pursuing the reform any time soon. “I support the exploration of Medicare for all, but you have to be well balanced and practical about this,” he said (emphasis added).
It appears Pelosi and Higgins found common ground (though what their dispute was over a public option remains a mystery). After their meeting, Higgins told the Buffalo News he would give his support to Pelosi and they agreed that he be the lead person on the Medicare Buy-In.
That the pair found common ground is not surprising. Pelosi has long been a darling of the private health industry. She collected more than $500,000 from the private health sector in contributions between 2017 and 2018. The private health industry would prefer a New Democrat like Higgins (who himself collected nearly $115,000 in industry money in 2018) to be the face of Democratic health care reform, as opposed to Alexandria Ocasio-Cortez or Bernie Sanders.
Higgins also has a close relationship with Rep. Richard Neal, the powerful ranking member (and likely the next chairman) of the House Ways and Means Committee, which is one of two committees to have jurisdiction over health policy. (The other one is the Energy and Commerce Committee.) Neal, who has received more than $2 million in his career from the industry, hosted a fundraiser breakfast for Higgins in 2017, indicating a close working relationship.
Rep. Frank Pallone (D-New Jersey), the ranking member of the Energy and Commerce committee, has received about $6 million from the health industry throughout his career and has said, “We [the committee] certainly would consider a Medicare buy-in.”
Single-payer strategists, according to the strategy call made in November, are targeting the chairs of these committees. To date, neither chair has given any words of support for single-payer.
“This is a fight that is not going to be easy,” said Gaffney. “The other side will always have more money and more political connections.”
Democrats: Hedging Their Bets on Medicare for All?
Higgins is hardly alone in showing equivocation in his “support” for single-payer. He supports exploring Medicare for All, but does he support passing it? It has been a common strategy for Democrats to offer co-sponsorship in the face of a mountain of grassroots pressure in the last few years but add a conjunctive adverb (“however,” “but” or “on the other hand”) and various caveats and qualifications.This was especially evident among senators who co-sponsored Sanders‘s Medicare for All bill in 2017. When Sanders’s bill garnered 16 co-sponsors, advocates were elated, and understandably so. In the past, Sanders could not find one solitary co-sponsor in the Senate for any single-payer bill.
But the great lengths some of these politicians went to distance themselves from their own support has been a source of concern among many advocates.
Then-Sen. Al Franken’s response might be the most absurd qualification his “support” for Medicare for All (this came before the Minnesota senator resigned over sexual misconduct):
Establishing a single-payer system would be one way to achieve universal coverage, and Senator Sanders’ “Medicare for All” bill lays down an important marker to help us reach that goal. This bill is aspirational, and I’m hopeful that it can serve as a starting point for where we need to go as a country. In the short term, however, I strongly believe we must pursue bipartisan policies that improve our current health care system for all Americans. (Emphasis added.)This is about as lukewarm of “support” as you could imagine for a bill that, if passed, would be arguably the most consequential domestic legislation in a generation.
Other Democrats, including possible presidential contenders, followed suit (before Franken’s scandal he had been rumored as a possible presidential contender as well). For instance, Sen. Cory Booker said he would co-sponsor the bill, but in doing so, said he “won’t rest until every American has a basic security that comes from access to affordable health care.
“Access to affordable health care” is not the same thing as a guarantee to comprehensive health care. In fact, the statement alone cedes health care as a commodity, which is not very different from the language the GOP used to try to make its reforms sound palatable — “universal access.” In countries like Canada, Japan and the United Kingdom, citizens don’t merely have “access to affordable care”; they are automatically enrolled — for life — under the nations’ single-payer systems.
Sen. Kamala Harris of California is also a co-sponsor of the bill, but in a later interview up with the Sacramento Bee, she said, “as we talk about moving toward a single-payer system, I think that there’s certainly momentum and energy around that, and when I get back to D.C., I’ll have a better sense of where people are now that they’ve been home.”
These high-profile equivocations worry some single-payer advocates.
“It has become difficult for any Democratic senator considering a 2020 presidential bid not to co-sponsor Sanders’ bill, a sign that support for single-payer will be the default position,” wrote Jim Newell in Slate. “These [co-sponsors] need to show, in short, that they’re not duping single-payer supporters to get their votes—that they care about single-payer health care as a government program they’re serious about implementing, and not just as a talking point.”
This weak-kneed support is seen outside of Congress as well. For instance, it became common for the press to conclude that former President Barack Obama has “endorsed” Medicare for All, when in fact, his comments were much less committal and somewhat confusing. Obama misidentified Medicare for All as a new idea, though he expressed support for the policy as far back as 2003.
Ocasio-Cortez and the Merits of Primary Challengers
Being concerned about the authenticity of some Democrats’ support for single-payer is one thing. Doing something about it is harder. While many Democrats who have co-sponsored Medicare for All have done so timidly, advocates are reluctant to be too harsh on these politicians. Winning new co-sponsors has been the major priority.This is one reason why Sanders’s bill did not get specific about financing (the staff chose to release a memo outlining possible ways to pay for the plan). The way his legislation was written allowed senators to co-sponsor without technically supporting any new taxes.
But, given the finite amount of time and political capital that exists, organizers say, politicians can’t play it safe much longer.
“Politicians will try very hard to avoid making hard decisions,” Solomon said. “But eventually, you have to decide: Is health care a right or not?”
One way to ensure that members of Congress who are sincere in their support for Medicare for All is to run primary opponents against Democrats who don’t advance single-payer. Many of the self-described Democratic Socialists won in the midterms through their strong support for Medicare for All and refusal to accept money from major corporate donors and the private health industry.
Ocasio-Cortez has endorsed this tactic, not just on health care but on many issues, to reform the party. Her victory is an example of a strong supporter of single-payer running against a politician whose decision to support single-payer was viewed with great skepticism among progressives. Joseph Crowley, was, like Higgins, among the 123 co-sponsors to HR 676 when he lost to Ocasio-Cortez. While Crowley had never endorsed the bill in past congressional terms, he did so in May 2017 after the Sanders campaign managed to push the issue into the national spotlight. Moderates like Crowley felt tremendous pressure from the left to co-sign single payer.
But voters were not fooled by Crowley’s about-face on Medicare for
All. As the public grows increasingly class conscious, they are can
better able to distinguish Democrats like Crowley, who is drowning in health insurance money
and has virtually no small donors, and a new breed of leaders like
Ocasio-Cortez, who do not rely on corporate money and whose support for
single-payer comes off as genuine.
“Primary challengers, when credible, can be very effective. Even if they do not win, they often move the incumbent on the issues,” Solomon said. “And they are a way to hold Democrats accountable to what they promise progressives along the way. Voters should make these judgments on who to challenge not on their words, but their actions.”
https://truthout.org/articles/biggest-threat-to-single-payer-democrat-support-for-a-public-option/?
“Primary challengers, when credible, can be very effective. Even if they do not win, they often move the incumbent on the issues,” Solomon said. “And they are a way to hold Democrats accountable to what they promise progressives along the way. Voters should make these judgments on who to challenge not on their words, but their actions.”
https://truthout.org/articles/biggest-threat-to-single-payer-democrat-support-for-a-public-option/?
Elizabeth Warren Wants to Stop Inequality Before It Starts
by Steven K. Vogel - The Boston Globe - January 3, 2019
As the Democrats take over the House and Democratic presidential hopefuls begin the slog toward the 2020 primaries, their party is also debating its economic policy vision for the future.
Senator
Elizabeth Warren, who just announced that she is forming an exploratory
committee for a presidential bid, offers a program that focuses more on
what the political scientist Jacob Hacker calls “pre-distribution” —
the pretax allocation of economic gains. Pre-distribution focuses on how
the seemingly arcane rules of the marketplace — like labor and
financial regulation — affect who profits most from economic activity in
the first place.
In contrast,
democratic socialists like Senator Bernie Sanders represent the
traditional liberal agenda of redistribution through the tax system as
well as generous social-welfare spending. Redistributive policies take
the market allocation of profits as a given and devise ways to moderate
the resulting inequalities after the fact.
Let
me be clear: We need all of the above to combat the rampant inequality
of wealth and power in the United States today. We need progressive
taxation to narrow the income gap and to generate revenue for public
investment. And we need government support for child care, medical care
and other services to support those who cannot work and to empower those
who can.
But
the Democratic Party would be smart to embrace Senator Warren’s
approach and a broader pre-distribution agenda as its next big idea
because it deals with the root causes of inequality in America and
therefore the voter frustration that helped make Donald Trump president.
Pre-distribution
is less costly than redistribution because it mostly entails regulatory
reforms rather than big spending items, like free college or job
guarantees. So it would not provoke many Americans’ deep-seated mistrust
of big government as much as calls for redistribution would.
Conservatives
argue that pretax earnings simply reflect the free operation of the
market, but they don’t. There is no pristine free market — just
real-world markets thoroughly sullied by imbalances of power and
regulations that favor corporations over workers. We should not be shy
about revising these regulations to achieve more equitable growth. This
would not undermine the capitalist economy; it would enrich it.
We tend to speak of the government and the market as adversaries
in economic policy debates. They aren’t. The government makes the
market work, with vast implications for public welfare. Getting serious
about pre-distribution means delving into all the things that
governments do to enable modern markets to function properly, from
corporate law to antitrust.
Last
summer, Senator Warren introduced the Accountable Capitalism Act, which
tries to tackle the deeper causes of inequality in wealth and power in
our country. It would require large corporations to obtain a federal
charter of corporate citizenship. Employees would elect at least 40
percent of board members.
Executives
would have to hold the stock shares they receive as compensation for at
least five years. And corporations would have to get approval from 75
percent of their shareholders and 75 percent of their directors to make
political campaign donations.
Corporations
are legal entities with distinct privileges, like limited liability, so
it would be perfectly reasonable for the government to require
corporate boards to include labor representatives. This would encourage
corporations to maximize profits by investing in their workers rather
than by cutting labor costs.
Beyond
corporations, a broader pre-distribution agenda would include labor
regulation, financial regulation and antitrust. For example, the
government should revise labor regulations to strengthen employees’
bargaining power, which would give them a fairer share of corporate
returns. The government should crack down on noncompete clauses, which
undermine workers’ ability to sell their labor to the highest bidder.
And it should restrict mandatory arbitration clauses in employment
contracts, which require workers to give up their right to take their
employers to court; such clauses were endorsed by a 5-4 Supreme Court
decision in May.
This
pre-distribution approach to labor would likely appeal to swing voters —
in particular, ones who voted for both Barack Obama and Mr. Trump —
more than the job guarantees proposed by Senator Sanders because
pre-distribution means fair pay rather than government largess.
Likewise,
financial regulation is not just about preventing financial
institutions from taking excessive risks or protecting small investors
from their own folly. It is also about something more fundamental: who
gets the returns from financial activity.
In
recent years, the relaxing of regulations has allowed financial firms
to enjoy greater profits and bank executives to win higher compensation
without delivering more value to ordinary investors. So the government
should reinforce the Dodd-Frank rules that constrain financial
institutions from padding profits via risky trading — not further ease
them, as the Trump administration proposes. It should bolster consumer
protection, not gut the Consumer Financial Protection Bureau. And it
should enhance the fiduciary rule, which requires investment advisers to
put their clients’ interests first, not refuse to enforce it.
On
antitrust, the government should be warier about corporate mergers, and
more aggressive in stopping dominant firms from squashing their
competitors. Over the past few decades, weak antitrust enforcement has
meant higher profits for companies that dominate their markets, fewer
opportunities for challengers, larger salaries for managers, higher
prices for consumers and lower wages for workers.
Financial
regulation and antitrust are central to Ms. Warren’s proposals for
leveling the economic playing field. She came to prominence for her
strong advocacy of consumer financial protection, and she has pushed for
tougher antitrust policies to curtail the economic and political power
of large corporations.
The
pre-distribution agenda, while rooted in the minutiae of government
regulation, actually has a simple core message. It is not about rigging
the system to benefit the poor and the middle class, but about unrigging
it from benefiting the wealthy and the powerful. It is about shaping
markets to allocate returns from economic activity more fairly in the
first place rather than trying to correct inequities after the fact.
In
essence, it is about giving consumers more value for their dollar and
workers the wages they are due. What could be the problem with that?
Employer group balks at fees to prop up MassHealth
A
prominent Massachusetts business group is calling for an immediate end
to new fees that cost employers across the state $300 million last year,
noting that Beacon Hill failed to follow through on its part of a
bargain to tame the rising costs of the state Medicaid program.
Governor
Charlie Baker proposed the fees and legislators approved them in 2017,
requiring employers, over two years, to contribute more toward the costs
of the state program that provides health coverage for poor and
low-income residents.
Associated
Industries of Massachusetts, a group representing 4,000 employers,
plans to submit a bill to the Legislature this month that would end the
fees right away — one year early.
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“It
feels like the reason this was created no longer exists,” said Richard
C. Lord, chief executive of AIM. “It feels like this [assessment] we can
eliminate in year two.”
Much
has changed since the Baker administration proposed the fees nearly two
years ago, Lord said. The fees have generated tens of millions more
than originally expected. Meanwhile, enrollment in the state Medicaid
program, known as MassHealth, has fallen, and program costs are not
growing as briskly as in previous years.
In
addition, state tax collections have exceeded targets over the past
several months, putting the state on firmer financial footing.
The
fate of the business group’s request is uncertain. The governor’s
office and leaders of the House and Senate did not say whether they
would support it.
Baker
first proposed the assessment in January 2017 — despite earlier pledges
from the Republican governor that he would not raise fees. He argued
that employers whose low-wage workers are enrolled in MassHealth should
pay more toward the costs of the program.
The proposal upset business groups, but after months of negotiations, administration officials scaled back their plan so
it had more support from employers. An existing assessment called the
employer medical assistance contribution increased from $51 to $77 per
employee. Employers also were required to pay up to $750 for each worker
who receives public health benefits. In exchange, employers received
some relief in unemployment insurance rates.
The
administration also proposed a series of changes to tackle the costs of
MassHealth, including toughening eligibility rules and covering fewer
prescription drugs. One proposal to move 140,000 adults from MassHealth
to other subsidized health plans was criticized by advocates, who said the change would hurt poor working families.
In the summer of 2017, the state Legislature, controlled by Democrats, rejected Baker’s cost-cutting ideas but approved the new fees on employers. (Federal officials also rejected the administration’s MassHealth proposals).
Later, the Senate and House each
approved health care bills, but neither bill focused on MassHealth, and
both died at the end of the formal legislative session in July when
lawmakers failed to work out a compromise.
The
new fees on employers, however, went into effect. Employers can request
a waiver from the fees if they prove a hardship. Of 246 such waiver
requests, administration officials said they have allowed 99.
Asked
whether the governor would support AIM’s request to end the fees early,
spokesman Brendan Moss said only that Baker would carefully review any
legislation that reaches his desk.
“The
Baker-Polito Administration proposed a series of reforms to protect
taxpayers from having to pick up the cost of other workers’ healthcare
and to ensure the health benefits are there for those who need them the
most,” Moss added in a statement.
Administration officials and top lawmakers don’t appear to be any closer to agreement on how to tackle costs in MassHealth.
Catherine
Williams, a spokeswoman for House Speaker Robert A. DeLeo, said the
speaker “is proud” that the House didn’t vote to change MassHealth
eligibility requirements.
“The
House will review any additional proposals on this issue via the
legislative process during the new session,” she said in a statement.
Senate
President Karen E. Spilka, said in a statement that senators will keep
working to minimize the “negative impacts” of fees.
“The
Senate will continue to take the lead on initiatives which focus on
reining in health care costs across the board while ensuring we increase
access to quality care,” Spilka added.
MassHealth
represents the single biggest chunk of the state budget, though about
half its costs are paid by the federal government. The program provides
health coverage for 1.85 million people in Massachusetts, including
low-income residents and those with disabilities.
Administration
officials have taken more modest steps to control MassHealth costs,
including by ensuring that only people eligible for benefits receive
them. They also restructured the program to push doctors and hospitals
to slash costs by keeping patients within set networks and better
managing their care.
Jon
B. Hurst, president of the Retailers Association of Massachusetts, said
policy makers should keep their focus on controlling the costs of
MassHealth — not on raising more revenue from small businesses.
The new fees have been a challenge for many employers, Hurst said: “It’s caused pain without fixing the real cost problem.”
What a French Doctor’s Office Taught Me About Health Care
I moved to Europe because I couldn’t afford to be a cancer
by Erica Rex - NYT - January 2, 2019
TOURS,
France — A dozen of us sit expectantly in the orthopedic surgeon’s
waiting room. We’re here for follow-ups. Some, like me, have had bunions
removed. Others have had hips or knees replaced. Most are older women.
The
copies of Paris Match and Le Monde on the table are at least six months
old. The only artwork is a framed print of Claude Monet’s “Poppy Fields
Near Argenteuil.” Since I’m only two weeks out from surgery and can’t
drive, I came by taxi. The fare was underwritten by the French social
security system, known familiarly as la Sécu, which also provides health insurance for all residents.
The
woman seated opposite me tells me she’s on her second bunion surgery.
Her doctor, a top orthopedic surgeon, charges more than the normal Sécu
compensation, as do many specialists. Most French people purchase a
supplementary insurance plan to cover costs not picked up by la Sécu. As
a French resident and taxpayer, I have one too.
Another
woman is recovering from a hip replacement. Medical chat is common in
French waiting rooms. If the wait is long, everyone comes to know
everything about one another’s complaints.
To
my friends in the United States, this casual attitude seems foolish,
even risky. But in France, medical privacy is irrelevant. No one will
lose her job because of a lengthy convalescence. There is no possibility that pre-existing conditions
will make insurance unaffordable. Unemployed people still receive
treatment. Huge medical bills do not reduce ordinary citizens to a state
of existential terror.
The absence of unease over health care alters the texture of French experience. We get cozy in waiting rooms.
A
woman in her late 60s sits next to me. She fidgets and appears close to
tears. She leans over and asks in a low voice how long it has been
since my surgery. She’s wearing the orthopedic boot, but unlike the rest
of us bunion ladies, she’s still using crutches. She tells me she had
surgery four weeks ago and believes something is wrong.
The woman across from me leans forward.
“Que s'est-il passé?” What happened? My neighbor describes a “sensation de craquement” — the feeling that the bones in her foot are crunching when she puts weight on it.
Three other women reassure her: The bone crunching is normal. Those bones had to be broken and realigned to reshape her foot.
Yes,
but the physical therapist told her that the doctor had botched
something. Now she’s frightened. The therapist was completely wrong, we
tell her. She seems relieved, but grows worried again when she realizes
she should have restarted physical therapy sessions a month ago.
Then the doctor appears and calls the woman’s name. Even rock-star orthopedists here don’t have nurses helping them in their offices.
The doctor changes his own examining table paper. His staff consists of
two foul-tempered office assistants who make appointments, take
payments and hand out prescriptions.
The woman picks up her crutches. He raises his hands in question.
The crutches? Still? She fights back tears. We reassure her it will be
fine. She limps after him into the examining room, dragging the crutches
in one hand.
I am an accidental
European. I developed breast cancer in 2009. With no continuing medical
coverage in the United States, and in desperate need of it, I moved to
Britain. Under the sponsorship of an acquaintance, I was granted
“indefinite leave to remain” and received care through the National
Health Service. When I moved to France four years ago, the French system
quickly took over covering me.
It
has taken me nine years to grow accustomed to the idea that my health
care won’t suddenly evaporate at the whim of a new government. Doctors
here often ask how I landed in Europe. When I tell them, they shake
their heads. American values are deranged, they say.
Sometimes
I encounter Americans for whom visiting France is like a trip to
Disneyland, only with foie gras, and they’ll ask about medical care.
One such visitor, on learning I have a “carte vitale,” a social security card, asked, “How did you score that?” as if health insurance was like box seats at a Yankees-Red Sox game
I don’t live in the promotional brochure version of France
those Americans are touring. France for me was not a vacation
selection. Moving to Europe was a choice weighed against other, grimmer
options for health care, which included the strong possibility of being
bankrupted by cancer treatment and winding up at the mercy of New York
State’s welfare system.
In France I
can rest assured I will not be refused care for any treatable condition,
including a painful bunion — or yes, even a recurrence of breast
cancer. All the same, I’d rather have been able to get coverage without
emigrating.
Too many Americans do
not realize how much better off they would be if they felt safer about
access to medical care. Imagine what might happen if everyone felt safe —
safe enough to talk about ailments in waiting rooms.
Universal health coverage in Indonesia: concept, progress, and challenges
by Rina Augustina, Ph.D. et al - The Lancet - December 19, 2018
Summary
Indonesia is a rapidly growing middle-income country with 262 million inhabitants
from more than 300 ethnic and 730 language groups spread over 17 744 islands, and
presents unique challenges for health systems and universal health coverage (UHC).
From 1960 to 2001, the centralised health system of Indonesia made gains as medical
care infrastructure grew from virtually no primary health centres to 20 900 centres.
Life expectancy improved from 48 to 69 years, infant mortality decreased from 76 deaths
per 1000 livebirths to 23 per 1000, and the total fertility rate decreased from 5·61
to 2·11. However, gains across the country were starkly uneven with major health gaps,
such as the stagnant maternal mortality of around 300 deaths per 100 000 livebirths,
and minimal change in neonatal mortality. The centralised one size fits all approach
did not address the complexity and diversity in population density and dispersion
across islands, diets, diseases, local living styles, health beliefs, human development,
and community participation. Decentralisation of governance to 354 districts in 2001,
and currently 514 districts, further increased health system heterogeneity and exacerbated
equity gaps. The novel UHC system introduced in 2014 focused on accommodating diversity
with flexible and adaptive implementation features and quick evidence-driven decisions
based on changing needs. The UHC system grew rapidly and covers 203 million people,
the largest single-payer scheme in the world, and has improved health equity and service
access. With early success, challenges have emerged, such as the so-called missing-middle
group, a term used to designate the smaller number of people who have enrolled in
UHC in wealth quintiles Q2–Q3 than in other quintiles, and the low UHC coverage of
children from birth to age 4 years. Moreover, high costs for non-communicable diseases
warrant new features for prevention and promotion of healthy lifestyles, and investment
in a robust integrated digital health-information system for front-line health workers
is crucial for impact and sustainability. This Review describes the innovative UHC
initiative of Indonesia along with the future roadmap required to meet sustainable
development goals by 2030.
Mills’ ‘Executive Order 1’ makes 70,000 more Mainers eligible for health insurance
by Joe Lawlor - Portland Press Herald - January 3, 2019
Gov. Janet Mills signed an executive order Thursday to expand Medicaid, fulfilling a campaign vow that ends the long delays imposed by the fervent opposition of her Republican predecessor, Paul LePage.
More than 70,000 Mainers will be eligible for MaineCare health insurance under the expansion. Mills, who had promised to act on “day one” of her administration, was sworn into office Wednesday evening and signed “Executive Order 1” on Thursday.
Mainers who think they are eligible for coverage can begin applying immediately, Mills’ office said. To find out how to do so, they can visit the Maine Department of Health and Human Services website. About 4,500 Mainers tried to sign up under expansion in 2018, but were rebuffed by the LePage administration.
Naomi Loss of Lisbon Falls said she’s been waiting for this day for nearly a year, ever since her daughter Bethany turned 26 and was no longer eligible to be on her mother’s health insurance. Bethany, who is uninsured, has epilepsy and severe cognitive and developmental disorders, but was denied Medicaid disability and did not qualify for subsidized Affordable Care Act insurance. Bethany’s medications cost more than $1,000 per month, and rebates from the pharmaceutical company that helped their family afford the medications were set to run out this year.
“When I heard the news, it was such a huge sigh of relief,” Loss said. “We have been putting off doctor’s visits because it’s just so expensive. I knew (Mills) said she would do this right away and made these promises, but when someone gets into office, you just don’t know how long it would take.”
Throughout the 2018 gubernatorial campaign, Mills said she would make implementing Medicaid expansion a top priority. Medicaid provides insurance coverage for low-income and disabled residents, and is operated by the states with federal oversight. Funding is a blend of federal and state dollars, with the federal government covering 90 percent of costs under expansion. Maine is expected to spend about $50 million per year on Medicaid expansion and receive more than $500 million in federal money.
“More than a year ago, the people of Maine voted to expand Medicaid. Today, my administration is taking the long-awaited steps to fulfill their will,” Mills, a Democrat, said in a written statement. “I am directing my administration to begin implementing Medicaid expansion as quickly and as efficiently as possible so that we can help more Maine people access the health care they need.”
Maine voters approved Medicaid expansion by 59-41 percent in a November 2017 referendum, but LePage refused to implement it. A lawsuit that attempted to force the LePage administration to implement the expansion won at every stage in court, but LePage dragged out the process, leaving it to Mills to act.
LePage continued his opposition Thursday, posting a statement to his new Twitter account that once again raise his oft-stated objection to expansion:
“The Democrats in the Legislature haven’t yet found sustainable funding for Medicaid expansion. Today’s Executive Order doesn’t have a way to pay.”
He concluded by saying: “I’ll be watching”
‘AS AGGRESSIVELY AS POSSIBLE’
Medicaid expansion is available to those earning up to 138 percent of the federal poverty limit – $16,753 for a single person, and $28,676 for a family of three.
According to a news release, the executive order “directs the Department of Health and Human Services to make changes to process the applications of Mainers seeking health care coverage under Medicaid expansion, including amending the filings of the previous administration to reflect the accurate date of implementation and to seek the earliest possible approvals as allowed under the expansion act.”
In a letter Thursday to Seema Verma, administrator of the U.S. Centers for Medicare and Medicaid Services, Mills said the people’s will was “unfulfilled.”The Democrats in the Legislature haven’t yet found sustainable funding for Medicaid expansion. Today’s Executive Order doesn’t have a way to pay. Doctors shouldn’t have to take IOUs from the state. We can’t go back to the days of owing the hospitals $750 million. I’ll be watching https://t.co/5Ef51KFNjK— Paul R. LePage (@PaulRLePage1) January 4, 2019
“Today I signed an executive order directing that expansion happen as smoothly, as efficiently, and – importantly – as aggressively as possible,” Mills wrote.
The coverage is retroactive to July 2, so Mainers who applied for Medicaid in 2018 but were denied benefits and incurred expenses that should have been covered by Medicaid will be reimbursed.
Jeanne Lambrew, who was nominated by Mills to be health and human services commissioner, said in a written statement, “Governor Mills and I share a commitment to ensuring that the Department of Health and Human Services achieves its core mission to safeguard the health and well-being of Maine children and families. The executive order is a critical first step in achieving that mission. Full implementation of Medicaid expansion will take time and the collective cooperation of our health system, but with Governor Mills’ leadership, access to affordable health care coverage for Mainers is now on the horizon.”
HOSPITAL NETWORK IS PREPARED
Robyn Merrill, executive director of Maine Equal Justice Partners, the group that campaigned for the referendum and sued the LePage administration for failure to implement it, said having an administration that supports the goals of Medicaid expansion “feels lighter and more hopeful.”
“The implications are significant for people’s lives,” Merrill said. “They won’t be delaying the care they need, like they did when they were uninsured. Medicaid expansion is going to become a reality, finally. It’s taken a long time.”
Thousands of Mainers with substance use disorder – rough estimates suggest 10,000 to 25,000 people – will gain access to treatment under expansion.
Lisa Letourneau, associate medical director of Maine Quality Counts who sees patients with opioid use disorder, said many patients with substance use disorder are uninsured, and Medicaid expansion will remove a barrier for them.
“This is going to be a lifesaving opportunity for a lot of people,” Letourneau said. A record 418 Mainers died of drug overdoses in 2017, and 180 through the first six months of 2018, according to state statistics.
Carol Zechman, director of Access to Care programs at MaineHealth, the parent company of Maine Medical Center and a network of hospitals and health care providers in much of southern and midcoast Maine, said patient capacity in the network should be able to absorb new Medicaid patients. The network has been planning for the expansion since the referendum was approved in 2017.
https://www.pressherald.com/2019/01/03/mills-signs-executive-order-to-implement-medicaid-expansion/
Good info out there, i would like to support your info with the definition of what is short term health insurance and how it can help people who left without coverage survive.
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